Provider Demographics
NPI:1760420509
Name:EVANS, DWIGHT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:CHARLES
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3063 CANYON VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9791
Mailing Address - Country:US
Mailing Address - Phone:909-824-6411
Mailing Address - Fax:
Practice Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM
Practice Address - Street 2:11201 BENTON STREET
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-0001
Practice Address - Country:US
Practice Address - Phone:909-583-6007
Practice Address - Fax:909-777-3236
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56590207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism